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Samenvatting Pre analytische fase - MLT2 - HoGent
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lOMoARcPSD|6865038Samenvatting pré-analytische fase
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1. Inleiding....................................................................................................................................................................... 4
1.1. ISO NORM 15189..................................................................................................................................................4
1.2. Pré-analytische fase..............................................................................................................................................4
2. De testkeuze................................................................................................................................................................5
2.1. Aandachtspunten bij sectie van een test..............................................................................................................5
2.2. ROC-curve.............................................................................................................................................................5
3. De testaanvraag...........................................................................................................................................................5
3.1. Het aanvraagformulier..........................................................................................................................................5
3.2. Het verloop van de aanvraag................................................................................................................................6
3.3. Het laboratorium-informatiesysteem (LIS)............................................................................................................6
4. Bloedstalen.................................................................................................................................................................. 7
4.1. Soorten bloedstalen.............................................................................................................................................7
4.1.1. Volbloed.........................................................................................................................................................7
4.1.2. Serum............................................................................................................................................................7
4.1.3. Plasma...........................................................................................................................................................8
4.1.4. Hemolysaat....................................................................................................................................................8
4.1.5. Antistolling.....................................................................................................................................................8
4.2. Serum vs. heparineplasma..................................................................................................................................10
4.2.1. Significant verschillende resultaten.............................................................................................................10
4.3. Bewaringsomstandigheden van de bloedstalen.................................................................................................10
4.4. Integriteit van het bloedstaal..............................................................................................................................11
4.4.1. Hemolyse.....................................................................................................................................................11
4.4.2. Icterie (xantochromie).................................................................................................................................12
4.4.3. Lipemie........................................................................................................................................................12
4.5. Andere stalen......................................................................................................................................................14
4.5.1. Urinestaal....................................................................................................................................................14
4.5.2. Cerebrospinaal vocht (csv)...........................................................................................................................14
4.5.3. Arterieel bloed.............................................................................................................................................14
5. Beïnvloedende factoren op de samenstelling van het bloedstaal..............................................................................15
5.1. ‘Niet-variabele’ biologische factoren..................................................................................................................15
5.2. Variabele biologische factoren............................................................................................................................16
5.2.1. Tijdsgebonden fluctuaties............................................................................................................................16
5.2.3. Voeding........................................................................................................................................................17
5.2.4. Ondervoeding..............................................................................................................................................17
5.2.5. Fysieke inspanning.......................................................................................................................................17
5.2.6. Hoogte.........................................................................................................................................................17
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5.2.7. Stress...........................................................................................................................................................18
5.2.8. Levensstijl....................................................................................................................................................18
5.3. Interfererende proces-gerelateerde factoren.....................................................................................................18
5.3.1. Houding van de patiënt................................................................................................................................18
5.3.4. Verkeerde ratio bloed/anticoagulans...........................................................................................................19
5.3.5. Gebruik van een stuwband..........................................................................................................................19
5.3.6. Afname van bloed uit infuus-arm................................................................................................................19
5.3.7. Hemolyse.....................................................................................................................................................19
5.3.8. Te lang of foutief staaltransport...................................................................................................................19
6. De bloedafname........................................................................................................................................................20
6.1. De veneuze bloedafname...................................................................................................................................20
6.1.1. Belang..........................................................................................................................................................20
6.1.2. De voorbereiding.........................................................................................................................................20
6.1.3. De ontsmetting............................................................................................................................................22
6.1.4. Het vullen van de buis..................................................................................................................................22
6.1.5. Afwerken van de procedure.........................................................................................................................22
6.2. Capillaire bloedafname.......................................................................................................................................23
6.3. Veiligheid bij bloedafname.................................................................................................................................23
6.3.1. Uitvoerder....................................................................................................................................................23
7. Transport naar lab en bewaring.................................................................................................................................24
7.1. Bewaring staalafname........................................................................................................................................24
7.2. Wijze van transport.............................................................................................................................................24
7.3. Problemen bij bewaring en transport.................................................................................................................24
7.3.1. Lange transportduur of bewaring: uitwisseling...........................................................................................24
7.3.2. Lange transportduur of bewaring: hemolyse...............................................................................................24
7.3.3. Warmte........................................................................................................................................................24
7.3.4. In vitro metabolisatie...................................................................................................................................24
7.3.5. Foutieve buis................................................................................................................................................24
7.3.6. Verdamping.................................................................................................................................................24
7.3.7. Licht.............................................................................................................................................................25
7.3.8. Het pocket-syndroom..................................................................................................................................25
7.3.9. Belangrijke voorbeelden..............................................................................................................................25
7.4. Stalen voor het lab microbiologie.......................................................................................................................26
7.5. Bewaaromstandigheden voor een aantal analyses.............................................................................................26
8. Staalontvangst in het lab...........................................................................................................................................27
9. Staalvoorbehandeling in het lab................................................................................................................................27
Centrifugeren.........................................................................................................................................................27
Omgang met stalen na centrifugatie......................................................................................................................27
Inspectie van serum en plasma.............................................................................................................................28
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Onteiwitten............................................................................................................................................................28
Verdunnen.............................................................................................................................................................28
Homogeniseren na ontdooien...............................................................................................................................28
Automatisering in pré-analytische fase.................................................................................................................28
Transport naar analyzer.........................................................................................................................................28
10. Foutbronnen in de pré-analytische fase..................................................................................................................29
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